Comparable Survival in Patients With Unresectable Hepatocellular Carcinoma Treated by Radiofrequency Ablation or Transarterial Chemoembolization | Gastroenterology | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
El-Serag  HBMason  AC Rising incidence of hepatocellular carcinoma in the United States.  N Engl J Med 1999;340745- 750PubMedGoogle ScholarCrossref
Fan  STLo  CMLiu  CL  et al.  Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths.  Ann Surg 1999;229322- 330PubMedGoogle ScholarCrossref
Colella  GBottelli  RDe Carlis  L  et al.  Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization.  Transpl Int 1998;11 ((suppl 1)) S193- S196PubMedGoogle ScholarCrossref
Fong  YSun  RLJarnagin  WBlumgart  LH An analysis of 412 cases of hepatocellular carcinoma at a Western center.  Ann Surg 1999;229790- 800PubMedGoogle ScholarCrossref
Poon  RTNgan  HLo  CMLiu  CLFan  STWong  J Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence.  J Surg Oncol 2000;73109- 114PubMedGoogle ScholarCrossref
Poon  RTFan  STTsang  FHWong  J Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon's perspective.  Ann Surg 2002;235466- 486PubMedGoogle ScholarCrossref
Kasugai  HKojima  JTatsuta  M  et al.  Treatment of hepatocellular carcinoma by transcatheter arterial embolization combined with intraarterial infusion of a mixture of cisplatin and ethiodized oil.  Gastroenterology 1989;97965- 971PubMedGoogle Scholar
Carr  BI Hepatic artery chemoembolization for advanced stage HCC: experience of 650 patients.  Hepatogastroenterology 2002;4979- 86PubMedGoogle Scholar
Lo  CMNgan  HTso  WK  et al.  Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma.  Hepatology 2002;351164- 1171PubMedGoogle ScholarCrossref
Llovet  JMReal  MIMontana  X  et al. Barcelona Liver Cancer Group, Arterial embolisation or chemoembolisation vs symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial.  Lancet 2002;3591734- 1739PubMedGoogle ScholarCrossref
Llovet  JMBruix  J Systemic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival.  Hepatology 2003;37429- 442PubMedGoogle ScholarCrossref
Curley  SAIzzo  FEllis  LMNicolas Vauthey  JVallone  P Radiofrequency ablation of hepatocellular cancers in 110 patients with cirrhosis.  Ann Surg 2000;232381- 391PubMedGoogle ScholarCrossref
Wood  TFRose  DMChung  MAllegra  DPFoshag  LJBilchik  AJ Radiofrequency ablation of 231 unresectable hepatic tumours: indications, limitations, and complications.  Ann Surg Oncol 2000;7593- 600PubMedGoogle ScholarCrossref
Nicoli  NCasaril  AMarchiori  L  et al.  Intraoperative and percutaneous radiofrequency thermal ablation in the treatment of hepatocellular carcinoma.  Chir Ital 2000;5229- 40PubMedGoogle Scholar
Rossi  SBuscarini  EGarbagnati  F  et al.  Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.  AJR Am J Roentgenol 1998;1701015- 1022PubMedGoogle ScholarCrossref
Livraghi  TGoldberg  SNLazzaroni  SMeloni  FSolbiati  LGazelle  GS Small hepatocellular carcinoma: treatment with radio-frequency ablation vs ethanol injection.  Radiology 1999;210655- 661PubMedGoogle ScholarCrossref
Curley  SAIzzo  FDelrio  P  et al.  Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients.  Ann Surg 1999;2301- 8PubMedGoogle ScholarCrossref
Bowles  BJMachi  JLimm  WM  et al.  Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors.  Arch Surg 2001;136864- 869PubMedGoogle ScholarCrossref
Buscarini  LBuscarini  EDi Stasi  MVallisa  DQuaretti  PRocca  A Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results.  Eur Radiol 2001;11914- 921PubMedGoogle ScholarCrossref
Iannitti  DADupuy  DEMayo-Smith  WWMurphy  B Hepatic radiofrequency ablation.  Arch Surg 2002;137422- 426PubMedGoogle ScholarCrossref
Poon  RTFan  ST Assessment of hepatic reserve for indication of hepatic resection: how I do it.  J Hepatobiliary Pancreat Surg 2005;1231- 37PubMedGoogle ScholarCrossref
Goldberg  SNGazelle  GSCompton  CCMueller  PRTanabe  KK Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation.  Cancer 2000;882452- 2463PubMedGoogle ScholarCrossref
Liu  CLFan  ST Nonresectional therapies for hepatocellular carcinoma.  Am J Surg 1997;173358- 365PubMedGoogle ScholarCrossref
Ngan  HLai  CLFan  STLai  ECYuen  WKTso  WK Treatment of inoperable hepatocellular carcinoma by transcatheter arterial chemoembolization using an emulsion of cisplatin in iodized oil and gelfoam.  Clin Radiol 1993;47315- 320PubMedGoogle ScholarCrossref
O'Suilleabhain  CBPoon  RTYong  JLOoi  GCTso  WKFan  ST Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma.  Br J Surg 2003;90325- 331PubMedGoogle ScholarCrossref
Primrose  JN Treatment of colorectal metastases: surgery, cryosurgery, or radiofrequency ablation.  Gut 2002;501- 5PubMedGoogle ScholarCrossref
Erce  CParks  RW Interstitial ablative techniques for hepatic tumours.  Br J Surg 2003;90272- 289PubMedGoogle ScholarCrossref
Achenbach  TSeifert  JKPitton  MBSchunk  KJunginger  T Chemoembolization for primary liver cancer.  Eur J Surg Oncol 2002;2837- 41PubMedGoogle ScholarCrossref
Llovet  JMReal  MIMontana  X  et al.  Arterial embolisation or chemoembolisation vs symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial.  Lancet 2002;3591734- 1739PubMedGoogle ScholarCrossref
Li  LWu  PHLi  JQZhang  WZLin  HGZhang  YQ Segmental transcatheter arterial embolization for primary hepatocellular carcinoma.  World J Gastroenterol 1998;4511- 512PubMedGoogle Scholar
Poon  RTNg  KKLam  CMAi  VYuen  JFan  ST Effectiveness of radiofrequency ablation for hepatocellular carcinomas larger than 3 cm in diameter.  Arch Surg 2004;139281- 287PubMedGoogle ScholarCrossref
Lee  HSKim  KMYoon  JH  et al.  Therapeutic efficacy of transcatheter arterial chemoembolization as compared with hepatic resection in hepatocellular carcinoma patients with compensated liver function in a hepatitis B virus-endemic area: a prospective cohort study.  J Clin Oncol 2002;204459- 4465PubMedGoogle ScholarCrossref
Bronowicki  JPBoudjema  KChone  L  et al.  Comparison of resection, liver transplantation and transcatheter oily chemoembolization in the treatment of hepatocellular carcinoma.  J Hepatol 1996;24293- 300PubMedGoogle ScholarCrossref
Ng  KKLam  CMPoon  RTFan  ST Portal vein thrombosis after radiofrequency ablation for recurrent hepatocellular carcinoma.  Asian J Surg 2003;2650- 53PubMedGoogle ScholarCrossref
Ramsey  DEKernagis  LYSoulen  MCGeschwind  JF Chemoembolization of hepatocellular carcinoma.  J Vasc Interv Radiol 2002;13S211- S221PubMedGoogle ScholarCrossref
Ng  KKPoon  RT Radiofrequency ablation for malignant liver tumor.  Surg Oncol 2005;1441- 52PubMedGoogle ScholarCrossref
Belghiti  JFarges  O Primary malignant tumors of the liver. Garden  OJed A Companion to Specialist Surgical Practice Hepatobiliary and Pancreatic Surgery. 2nd ed. Philadelphia, Pa WB Saunders2002;124Google Scholar
Original Article
December 1, 2006

Comparable Survival in Patients With Unresectable Hepatocellular Carcinoma Treated by Radiofrequency Ablation or Transarterial Chemoembolization

Author Affiliations

Author Affiliations: Departments of Surgery (Drs Chok, Ng, Poon, Lam, and Fan) and Radiology (Drs Yuen and Tso), Centre for the Study of Liver Disease, University of Hong Kong, Pokfulam, Hong Kong.

Arch Surg. 2006;141(12):1231-1236. doi:10.1001/archsurg.141.12.1231

Hypothesis  The survival benefits of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are similar for patients with unresectable hepatocellular carcinoma amenable to either treatment.

Design  Retrospective comparative study.

Setting  Tertiary care institution.

Patients  From February 22, 2001, to March 10, 2004, 91 patients with unresectable hepatocellular carcinoma (tumor diameter <5 cm and <4 tumor nodules) treated by either TACE or RFA were analyzed from a prospective database.

Main Outcome Measures  The treatment-related morbidity, mortality, overall survival, and time to disease progression.

Results  Forty patients received TACE and 51 patients received RFA during the study period. Demographic data were comparable in both groups of patients. The treatment-related morbidities of TACE and RFA were 10% and 28%, respectively (P = .04). There was no treatment-related mortality in either group. There was 1 patient (2%) with complete tumor remission in the TACE group, and the complete ablation rate in the RFA group was 96%. The time to disease progression was similar in both groups (P = .95). The overall survival rates at 1 and 2 years were 80% and 58%, respectively, in the TACE group and 82% and 72%, respectively, in the RFA group (P = .21).

Conclusions  The overall survival and time for disease progression were similar in both groups of patients. In terms of the survival result, the efficacies of RFA and TACE were comparable for patients with unresectable hepatocellular carcinoma.